Prescription drug abuse: insights

Prescription drug abuse is a worldwide issue and in Australia, plays a significant role in the forces of addiction and overdose, with the worst outcome being death due to multiple drug toxicity. Deaths from prescription drug overdose are mostly from combined drug toxicity, from having too much of more than one drug in the system.

According to a 2016 report by The Australian Family Physician, investigations into overdose deaths in Australia found that prescription drugs were contributing factors in 80% of cases. This is an alarming percentage. The devastation is profoundly felt by the family and friends left behind. Left behind to piece together how their loved one came to ingest so many ‘legal’ drugs. So many, that it killed them. This is what happened to my son and I am left to wonder how on earth it can be that he had at his disposal so many different medications.

Too many central nervous system depressant drugs in a person’s system will result in the respiratory centre at the base of the brain simply ceasing to work. The person then can’t clear their airway. I won’t describe the grim physical facts any further – you get the picture. Another mother I know who also lost her son, described the current drug problems of society as a ‘whole generation of young people being taken by drugs’. She may not be far from the truth.

The most widely prescribed of these problematic drugs are analgesics and sedatives. These include drugs such as codeine which is found in multiple preparations, a common one being panadeine or panadeine forte. Oxycodone (Endone) is another analgesic or painkiller for moderate to severe pain, and morphine which is reserved for severe pain but which, in tablet form, is Oxycontin and is another of the prescription drugs being abused. Then there are the anxiolytics (anxiety reducing drugs) and sedatives (hypnotics). Drugs such as diazepam (Valium) and oxazepam (Serepax) which are benzodiazepines, are commonly prescribed for anxiety, but are meant to be used on a short term basis, such as 2-3 weeks and furthermore, should be used in combination with alternative therapies, such as seeing a psychologist for cognitive behavioural therapy (CBT), to assist the person with management of their anxiety. These anti-anxiety drugs are highly addictive and the withdrawal process is so complex if the person ends up taking the medicine on a long term basis. This could occur with prolonged episodes of anxiety due to life circumstances or if the person is addicted and is obtaining the prescriptions from more than one doctor, a process known as ‘doctor shopping’. There are also drugs used in the treatment of insomnia such as temazepam (Temaze) and stronger hypnotics such as rohypnol, which is notorious for its reputation as a drug of abuse.

There are also other drugs such as tramadol (Tramal), which is a synthetic opioid used for moderate to severe pain and pregabalin (Lyrica) which is used commonly for nerve pain, but which are being abused on the streets for their ability to give a ‘high’ or a sense of euphoria. There has been a gradual increase in prescribing rates of opioid pain killing drugs since late last century for reasons best explained by the medical profession. It is certainly a complex issue, as it is not just young people using these medicines and it is not the stereotypical unemployed ‘druggie’ who is getting caught up in this quagmire of drug abuse and misuse. The populations of people who are prescribed these drugs are many and varied, ranging from young adults to the elderly and include people who may have depression and anxiety or issues with chronic pain. People can, and do, become addicted to these medications even when used as prescribed. In the hands of responsible doctors and with a willing and cooperative patient who does not have any predisposing factors for addiction, these medications have their place in society and serve people well when used correctly and for the right reasons. But there is another, not so pleasant scenario where there is fault on both sides. Haphazard prescribing, doctor shopping patients, people who have problems with addiction, either established or emerging; and the reality is that many people fall through the gaps, continue to take these medicines and obtain them either legally or illegally, and enter into an unpleasant and dangerous cycle of addiction. Is everyone going to go to multiple doctors to get their drugs? No. Is everyone prescribed these drugs, going to try to buy them illegally? No. Will everyone prescribed these medicines become problematically addicted? No. But there is a group of people who will.

There are different categories associated with these drugs such as prescription drug abuse and misuse. Misuse occurs when people use these drugs in a way that is contradictory to the way they are prescribed, for example they may take 4 tablets instead of 2, for real symptoms of pain or discomfort. Perhaps the pain is out of control and unbearable and the person does not think about the possible consequences of taking too many, or maybe there is simply no regard for adverse effects and the person wants to feel the euphoria commonly associated with these drugs. The second scenario is one of abuse, where the person does not have any symptoms of pain, discomfort or anxiety, to the extent that the drugs are used solely for the ‘high’ or ‘buzz’ that results from taking more than prescribed or rather, where the drug isn’t even needed, and the person simply takes a handful of the medication for it’s mind altering effects. Either way is dangerous.

There is no end of programs for pain management, there are therapists for addiction, places where you can detox from these drugs; there are mental health clinicians, psychologists and psychiatrists, the list is endless for support persons to manage drug addiction and the co-occurring mental health and physical health issues which arise from abuse of these medications. In Australia, we have a system where there is a therapist, hospital, doctor or support group for just about every problem imaginable. There are guidelines for clinicians and centres for the patient, places where people can go to supposedly work through this addiction process and halt it in it’s tracks and purportedly have you on the ‘straight and narrow’ in no time. There are also so many people who do not get offered these choices and so many people who fall through the cracks in the system and oh, if only life were so simple. The health system doesn’t work so smoothly, at least not for some anyway and particularly not for people with addiction and mental health issues. Stigma is alive and well in Australia.

No amount of debate will bring me back my son but debate and discourse surrounding the subject may help another family out there who is going through a similar situation. Debate may help future generations. Debate may help current users who don’t know where to turn, or help the family of someone who is addicted. Help can be found, but unfortunately, the person who is addicted needs to want help to stop the addiction process. You can lead a horse to water…